CAUSES OF JAUNDICE By Manjulah Luckhmana, Monash

2y ago
97 Views
2 Downloads
412.08 KB
5 Pages
Last View : 1m ago
Last Download : 2m ago
Upload by : Milo Davies
Transcription

CAUSES OF JAUNDICEby Manjulah Luckhmana, Monashupdated 25 Aug 2013CAUSESEXAMPLESPREHEPATIC DISORDERS1. Neonatal[Bhandari, 2013; Hansen,2013]Physiological jaundiceIncreased bilirubin load due to increased RBC volume*Increased enterohepatic circulation **Decreased uptake by liver – decreased ligandinsDecreased conjugation – decreased UDPGT activityDecreased excretion into bilePremature babiesJaundice due to breast feedingPathologicalHaemolytic anaemias (Increased destruction of RBC) Haemolytic Disease of the Newborn (HDN)- Rhesus, ABO incompatibility, allografts RBC enzyme defects (G6PD deficiency, Pyruvate kinase deficiency),RBC membrane defects (Hereditary spherocytosis), Thalassemia,Drug induced (Vit K, Suphonamides, Nitrafurantoin, Anti-malarials,Penicillin), SepsisBleeding Haemorrhage (in any system)Increased enterohepatic circulation** Intestinal atresia/ stenosis, pyloric stenosis, Hirschsprung’s diseasePolycythaemia*Defective conjugation Congenital deficiency of UDPGT enzyme - Criggler –Najjar UDPGT inhibition by drugs (Novobiocin)Metabolic conditions Galactosaemia, HypothyroidismDecreased binding of bilirubin to albumin Drugs – Sulphonamides, Penicilin, Gentamycin Acidosis, Asphyxia, Hypothermia, Hypoglycemia2. Hemolytic disorders[Kumar and Clark, 2009;Pratt and Kaplan, 2012;Hansen, 2013]Inherited ***Spherocytosis, Elliptocytosis, G6PD deficiency, Pyrvate Kinase deficiencySickle cell anaemiaAcquiredMicroangiopathic Haemoytic Anaemia (MAHA), Paroxysmal nocturnalhaemoglobinuria, spur cell anaemia, immune haemolysis, parasiticinfectionsInfectiveMalaria, Babesiosis, LeptospirosisHypersplenism

3. Ineffectiveerythropoiesis[Pratt and Kaplan, 2012]InheritedThalassemiaVitamin deficiencyCobalamin (B12), Folate, Iron4. Inherited disorders[Pratt and Kaplan, 2012;Hansen, 2013]Haematological disorders ***Spherocytosis, Thallassemia, G6PD deficiency, Sickle Cell diseaseInability to process /breakdown bilirubinCongenital deficiency of UDPGT enzyme - Criggler Najjar Syndrome,Reduced activity of glucuronyltransferase enzyme- Gilbert’s Syndrome5. Medical treatment[Stiener, 1944]6. Drugs[Pratt and Kaplan, 2012;Hansen, 2013]7. OthersBlood transfusionRifampicin, Probenecid, Ribavarin, RIfamycinCongestive heart failure [van Lingen et al, 2005]

INTRAHEPATIC DISORDERS8. Inherited[Pratt and Kaplan, 2012;Hansen, 2013]9. Autoimmune[Pratt and Kaplan, 2012]10. Acquired[Pratt and Kaplan, 2012;Hansen, 2013]11. Drugs and chemicalsCholestasisInability to secrete conjugated bilirubin - Dubin Johnson Syndrome,Defect in hepatic storage of bilirubin - Rotor Syndrome,Benign Recurrent Intrahepatic CholestasisMetabolic defectsWilsons diseaseAutoimmuneAutoimmune Hepatitis*Hepatocellular conditionsHepatitis (Viral- A,B,C,D,E / Bacterial)EBV, CMV, HerpesLiver Abscess,Liver Cirrhosis (Alcoholic, Non Alcoholic, Cryptogenic)Primary or Secondary liver malignanciesCholestatic conditionsIntrahepatic Viral hepatitis Alcohol hepatitis Drug toxicityo Pure cholestasis – anabolic and contraceptive steroidso Cholestatic hepatitis – Chlorpromazine, Erthromycino Chronic cholestasis – Chlorpromazine Primary biliary cirrhosis Primary sclerosing cholangitis Sarcoidosis Inheritedo Progressive familial intrahepatic cholestasiso Benign recurrent cholestasis Cholestasis of pregnancy Total parenteral nutrition Post operative cholestasis Paraneopastic syndromes Graft versus Host disease Infiltrative diseaseo TB, Lymphoma, Amyoidosis Infectiono Malaria, Leptospirosis Alpha 1 antitrypsin deficiency [Hutchison and Hogarth, 2013]Halothane, Methyldopa, BarbituratesLead Poisoning, Carbon tetrachloride [Hansen 2013]

POST-HEPATIC DISORDERS12. Congenital13. Acquired[Pratt and Kaplan, 2012;Hansen, 2013]CholestasisBiliary atresia, Choledochal cysts [Pratt and Kaplan, 2012; Hansen 2013]CholestasisExtrahepatic Malignanto Cholangiocarcinomao Pancreatic cancero Gallbladder cancero Ampullary carcinoma Benignoooooooo14. Autoimmune15. DrugsCholedocholithiasisPostoperative biliary stricturesPrimary scerosing cholangitisChronic pancreatitisAIDS cholangiopathyMirizzi’s syndromeParasitic disease Extraductal - Ascariasis Intraductal - Clonorchis sinensis and FasciolahepaticaPostoperative stricture formationPrimary Sclerosing Cholangitis, Primary Biliary Cirrhosis [Hansen, 2013]Isoniazid, halothane, macrolides (e.g. erythromycin), amoxicillin-clavulanate,azathioprine, chlorpromazine, and several other drugs cause cholestasis, typicallywith hepatitis. [Padda et al, 2011]

References: Bhandari V. Neonatal Jaundice. Best Practice. British Medical monograph/672/highlights/overview.html,updated 12 Apr 2013, accessed 14 Aug 2013Bonheur J. “Biliary Obstruction Clinical Presentation.” Medscape. -clinical#a0218, updated 5 January 2012,accessed 15 Aug 2013Clark M, Kumar P. "Jaundice." Clinical Medicine. 7th ed. N.p.: Saunders Elsevier, 2009. Pp329-333.Hansen, T. "Neonatal Jaundice Clinical Presentation." Medscape. al#a0218, updated 21 June 2012, accessed12 Aug. 2013.Hutchison P, Hogarth DK. Alpha 1 Antitrypsin deficiency. Best Practice. British MedicalJournal, h/1075.html, last updated 4June 2013, accessed 15 Aug 2013Padda MS, Sanchez M, Akhtar AJ, Boyer JL. Drug induced cholestasis. Hepatology. 2011 April;53(4): 1377–1387.doi: articles/PMC3089004/Pratt DS, Kaplan MM. Jaundice. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL,Loscalzo J, eds. Harrison's Principles of Internal Medicine. 18th ed. New York: McGraw-Hill;2012, p324-9Steiner RE. Jaundice after Transfusion of Whole Blood or Human Plasma. Br Med J. 1944 Jan22;1(4333):110-1van Lingen R, Warshow U, Dalton HR, Hussaini SH. Jaundice as a presentation of heartfailure. J Royal Soc Med 2005 August; 98(8): 357–359.

1. Neonatal [Bhandari, 2013; Hansen, 2013] Physiological jaundice Increased bilirubin load due to increased RBC volume* Increased enterohepatic circulation ** Decreased uptake by liver – decreased ligandins Decreased conjugation – decreased UDPGT activity Decreased excretion into bile Premature babies Jaundice due to breast feeding Pathological

Related Documents:

jaundice must have their level of conjugated bilirubin measured. Preterm infants on long-term parenteral nutrition may develop conjugated jaundice which generally improves with the introduction of enteral feed and weaning of intravenous nutrition. Keywords: Neonatal jaundice, kernicterus, conjugated jaundice, phototherapy, exchange transfusion

NICE clinical guideline 98 – Neonatal jaundice 3 Introduction Jaundice is one of the most common conditions needing medical attention in newborn babies. Jaundice refers to the yellow colouration of the skin and the sclerae (whites of the eyes) caused by the accumulation of bilirubin in the skin and mucous membranes.

JAUNDICE Hepatocellular Jaundice: Due to Damage to liver cells Obstructive Jaundice: results from obstruction of the common bile duct. Obstruction can be a tumor or bile stones may block the duct preventing passage bilirubininto the intestine. Neonatal jaundice:Majority of newborn infants show a rise in bilirubin in the

Jaundice is the most common morbidity in the first week of life, occurring in 60% of term and 80% of preterm newborn. Jaundice is the most common cause of readmission after discharge from birth hospitalization.1 Jaundice in neonates is visible in skin and eyes when total serum bilirubin (TSB) concentration exceeds 5 to 7 mg/dL.

NICE clinical guideline 98 – Neonatal jaundice 3 Introduction Jaundice is one of the most common conditions needing medical attention in newborn babies. Jaundice refers to the yellow colouration of the skin and the sclerae (whites of the eyes) caused by the accumulation of bilirubin in the skin and mucous membranes.File Size: 1MBPage Count: 54

What is Jaundice Neonatal jaundice Definition Neonatal jaundice is the term used when a newborn has an excessive amount of bilirubin in the blood. Bilirubin is a yellowish-red pigment that is formed and released into the bloodstream when red blood cells are broken down. Jaundice comes from the French word jaune, which means

Physiological jaundice peaks on day 4 or 5 and then gradually disappears over 1-2 weeks. 5. Judging Jaundice: Jaundice starts on the face and moves downward. Try to determine where it stops. View your baby unclothed in natural light near a window. Press on the yellow skin with a finger to remove the normal skin tone.

The Power of the Mind Copyright 2000-2008 A. Thomas Perhacs http://www.advancedmindpower.com 3 Laws of the Mind Law #1 Every Mental Image Which You Allow to Take